She said patients sometimes tried to contact GPs to let them know they would have to miss an appointment, but were unable to get through.

"Doctors could help by making sure there is some facility, such as an answerphone, so patients can let them know."

But she added: "The BMA is not in favour of charging patients who miss appointments."

'Responsibilities'

Professor David Haslam, chairman of the Royal College of GPs, said: "Every GP wants to give high quality care with good access. Every missed appointment is a wasted opportunity for another patient.

"Those few patients who repeatedly miss appointments are depriving other patients of care."

But he said GPs could do more to help: "More practices are guaranteeing rapid access, which should make it unnecessary for patients to book a future appointment 'just in case'."

Simon Williams of the Patients' Association said: "These figures clearly show how patient education campaigns like 'Keep It Or Cancel It' have helped reduce the number of missed GP appointments by an impressive 3.5 million.

"While the number of appointments missed remains very high, it clearly shows the effectiveness of initiatives that takes into consideration both doctors and patients."

A spokesman for the Department of Health said: "Patients are right to expect a modernised, responsive and accessible service.

"Increasingly that is the case, with most people now having the opportunity to be seen by a GP within two days.

"But for their part, patients have a responsibility to keep or cancel appointments."